Amongst other things, the invention seeks to define a protocol for automatically preparing samples of total blood for the purpose of improving the reliability of analyses performed using automatic analyzers, and also to improve the flexibility with which such analyses can be implemented with the help of such automatic analyzers.
Blood analyses performed on total blood (hematological analyses) are performed on tubes of blood that contain all of the components of blood, unlike analyses that are performed on blood serum or plasma, as obtained after coagulating or centrifuging samples of blood taken from patients.
In order to be carried out properly, such analyses on total blood require sustained agitation of the tubes of blood for analysis in order to thoroughly mix all of the components of the blood such as the platelets and the red and white corpuscles that are to be counted during analysis. This agitation stage is essential for ensuring the quality of the analyses and it must be carried out very shortly before analysis and in compliance with criteria that are standardized.
Tubes of blood for analysis are identified by bar codes giving access to information relating to the patients and also to the analyses that are to be performed on the samples of blood contained in the tubes.
These tubes are sorted by category and they are placed on supports, commonly referred to as racks, that are suitable for receiving a plurality of tubes. After prior agitation they can then be introduced manually and individually into an automatic analyzer. The tubes can also be placed in cassettes or racks that are specific to each analyzer and that have about ten housings in alignment, in which the tubes are placed and generally secured manually by an operator, who then places said cassettes or racks in a loading compartment of the analyzer.
Said cassettes are then taken in charge automatically by the analyzer, which then performs the operations of conveying, agitating the tubes, analyzing the samples of blood contained in each of the tubes, and finally storing said cassettes once all of the tubes of blood placed thereon have been analyzed.
Such automatic analyzers suitable for taking charge of cassettes or racks carrying a plurality of tubes of blood for analysis are described in particular in the following documents : U.S. Pat. No. 4,609,017, EP-A-0 726 453, and EP-A-0 645 006.
The use of such automatic analyzers is nevertheless not entirely satisfactory. Regardless of the mode of analysis used, the operator needs to transfer each of the tubes manually from a rack into the analyzer or a cassette, and then after analysis the operator needs to extract the tubes from the analyzer or from said cassette in order to replace them on racks, so that they can be conserved for a short period in refrigerators in order to make it possible to analyze them again, should that be necessary in order to verify that the results of particular analyses are exact.
For each tube for analysis, the operator thus needs to take care to engage the tube of blood properly in the cassette, to turn it so as to make its bar code label visible to the reader so that it can be identified, and to avoid becoming contaminated with the blood.
Furthermore, when it is appropriate to verify a first result, it is difficult for the operator to identify amongst the set of tubes, which tube needs to be analyzed again. The operator needs to verify each of the bar code labels on the tubes in order to identify visually the tube containing the sample that needs to be verified, and then needs to reintroduce said tube individually into the analyzer (or else the entire cassette on which said tube is located), which can be particularly time consuming and lengthy to perform.
Implementing hematological analyses with the help of present analyzers thus lacks flexibility.
Automatic systems are also known for feeding tubes for analysis from a storage zone to an analysis point where they are taken into charge by one or more analyzers, as described in document U.S. Pat. No. 5,232,081. That comprises a system for conveying cassettes filled with tubes and placed on a rail that transports the cassettes from one analyzer to another, starting from a storage compartment, with the cassettes being put into place on the conveyor rail automatically as a function of the rate of throughput of the analyzers. Automatic systems of that type for feeding analyzers with tubes of blood do not solve the above-defined problems of flexibility in implementing analyses, even though they do enable them to be carried out at a faster rate.
In addition, conveying entire cassettes requires a conveyor system of large dimensions to be built so as to enable the direction of cassettes to be changed on the system, on curves of small radius, which makes the use of such cassette conveyor systems particularly inconvenient and difficult in laboratories.
Document EP-A-0 344 819 describes a device serving essentially to store and mix tubes of blood for analysis. The device makes provision only for agitating the tubes and not for any other step in preparing samples. Each tube is placed on an individual support in a storage zone and then the tubes are moved in succession one by one by a mechanism that is very complex and bulky to the agitator device and to a zone giving access to an analyzer.
Although automatic, that device suffers from the same drawbacks as analysis devices using cassettes. It is necessary for the operators to introduce the tubes one by one into their supports in the storage compartment. In addition, its operation does not provide any flexibility in the order in which tubes are prepared and analyzed.
Better flexibility is obtained by a device of the kind described in document U.S. Pat. No. 4,927,545. That document describes a device for automatically treating blood serum, the device comprising a computerized control unit driving a 5-axis robot arm that handles tubes of blood serum between various apparatuses. Nevertheless, that device is very bulky which makes it unsuitable for use in laboratories where a very large number of analyses need to be performed every day and where a large number of operators work and move about. In addition, the device of U.S. Pat. No. 4,927,545 is unsuitable for treating samples of total blood, insofar as it does not enable tubes to be prepared individually in automatic manner.
Another drawback of existing automatic analyzers and automated feeder systems lies in the fact that they are not suitable for coping with emergency situations of the kind commonly encountered in analysis laboratories. In such emergency situations, it is essential for an operator to be able to carry out an analysis on a tube of blood that is not in the analyzer or on the feed system of the analyzer, so as to be able to obtain results immediately. To do this, the operator is obliged to stop the analyses that are in progress, in order to introduce the tube for emergency analysis into a cassette ready for entering the analyzer and taking the place of one of the tubes to be found therein. Thereafter, once the emergency analysis has been carried out, the normal analysis process that was stopped needs to be restarted. That likewise represents operations that are constraining and lengthy for the operator and also leads to untimely stoppages in the process of routine analyses, thus interfering with the reliability of the analyses performed and thus in the accuracy of the results provided.
The device described in EP-A-0 344 819 is unsuitable, in particular, for coping with such emergency situations.
Finally, before beginning to analyze tubes of blood, operators need every day to perform quality control operations on analyzers, by analyzing tubes containing control samples of blood for which the various parameters have known values with known tolerances relative to said values, in order to verify that the measurements performed by the analyzer are exact, and where appropriate in order to adjust the analyzer in suitable manner so that it will subsequently perform correct analyses on unknown samples. With certain national legislations, it is necessary to perform such quality control operations several times a day in order to be certain that the analyzers do not drift out of adjustment during the day and that the quality of the analyses remains constant at all times.
Tubes containing control samples of blood need to be stored in refrigerators while they are not in use, so that for each quality control operation, operators must stop the analyzer, then take an appropriate control sample tube from a refrigerator, verify that the tube is indeed appropriate for the operation that is to be performed, and in particular that the blood in the control sample has not reached its use-by date and has not already been subjected to too great a number of analyses. Thereafter, it is necessary to allow the control sample tube to return to room temperature and then to perform quality control operations by analyzing the control sample in compliance with the standards in force, and finally, once quality control is finished, the tubes must be put back into the refrigerator, after which normal analyses can be restarted.
There also, the operations of performing quality control on analyzers are particularly lengthy and laborious for operators to implement, and it can happen they do not give sufficient care to complying with the conditions under which tubes of control sample blood need to be conserved and used.